Lancet Commission Maps Roadmap to Counter Catastrophic Threats

Global experts warn that today's decisions across health, finance, climate, defense and security sectors will determine how many years of good health future generations gain - or lose - to preventable illness and early death by 2100.

The health of the next generation will be shaped not by one defining crisis, but by a set of 17 interlinked catastrophic threats spanning disease, social and economic conditions, environmental change, technology and conflict, finds a new Commission published in The Lancet and launched at the World Health Summit 2026 in Berlin. For the first time, it provides decision-makers with a common framework to understand these threats and target action.

Drawing on historical evidence and new risk analysis covering 204 countries and territories from the Institute for Health Metrics and Evaluation (IHME), authors of The Lancet Commission on 21st Century Global Threats to Health examined hundreds of possible threats. Of those, the authors identified 17 that pose the greatest danger to human health and survival between 2025 and 2100 - and that governments, funders and industry have a realistic route to act on through policy change, funding decisions and innovation.

The Commission identifies two threats as having extinction-potential:

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The catastrophic threats to health also include:

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These threats extend far beyond health alone, jeopardizing global prosperity, security and stability. The Commission's forward-looking assessment provides three recommendations for leaders across the health, finance, defense, climate and security sectors and beyond to address these risks before they escalate into crises: build threat-ready health systems, accelerate investment in breakthrough innovation, and strengthen the monitoring of emerging risks to better protect societies and economies.

For each threat, the Commission modelled a plausible best-case and worst-case future. The gap between them - measured in amenable disability-adjusted life years (DALYs), or the number of years in good health that are lost due to sickness, disability or premature mortality that could be avoided with targeted action – show decision-makers where investment and innovation can make the greatest difference.

A threat was identified as catastrophic if it met three key criteria: it could account for at least one billion DALYs by 2100, there is sufficient data to model the threat, and where there is sufficient scope for policy action.

Commission co-chair Professor Christopher JL Murray, Director of the Institute for Health Metrics and Evaluation, University of Washington, says: "The striking finding is not only the scale of these threats, but that humanity still has the agency to act. Across all 17 catastrophic threats, the decisions made by leaders today will shape the health and wellbeing of the next generation. But delaying action will only serve to shift and increase the costs into the future."

Co-Chaired by Dr. Murray and Dr. Natalia Kanem, Former Executive Director of the United Nations Population Fund (UNFPA), the Commission was informed by the expertise of 35 leaders spanning health, economics, security, governance, and technology, offering a globally relevant perspective.

If current trends continue, the 17 catastrophic threats collectively could account for tens of billions of years of lost health. While the scale varies by threat and region, every country faces significant risks. Within each country, the health harms will also be distributed unequally, with people in resource-limited settings and marginalized communities bearing the greatest burden, compounded by existing inequalities.

Dr. Murray adds: "The estimates highlight how much health loss could be avoided in each area. Some are already imposing substantial health burdens today, while others carry a real danger if they materialize. Crucially, all 17 threats are interconnected, which is why they must be addressed together, not in isolation."

Key findings include:

• While the likelihood of nuclear conflict and the malicious use of AI remain low, they present consequential threats because of their potential for extinction. Accounting for both their potential impact and probability, the Commission's assessment finds action to prevent nuclear conflict could avert an estimated 133 million deaths and 9.35 billion DALYs by 2100, while action to reduce the risk of malicious AI could avert an estimated 10.4 billion DALYs.
• Climate change is already a catastrophic and urgent threat to health and human survival. The Commission finds that limiting global warming to around 1.8°C (rather than letting it reach 4.4°C) could prevent 1.89 billion years of healthy life from being lost to causes like extreme heat and air pollution. The true burden is likely even greater, as this estimate only captures direct harms we can measure today, excluding harder-to-quantify effects such as displacement, drought and mental health impacts. Without sharp cuts to emissions, these losses will continue to compound beyond 2100 and increasingly intensify other threats, such as migration, in ways not yet reflected in these numbers.
• 16.1 billion DALYs are amenable to improvements in educational attainment, with women and children in sub-Saharan Africa facing the greatest potential burden of associated health loss. Faster progress on education will substantially improve health outcomes and reduce mortality rates among educated mothers' children, while indirectly contributing to slower population growth over the longer term.
• Income inequality could impose an amenable health burden equivalent to 25 COVID-19 pandemics by 2100, accounting for an estimated 13.8 billion DALYs.
• Obesity is a significant and growing health burden that is forecast to compound over time, contributing to 23.1 billion potential DALYs by 2100 that could be avoided through policies to reduce obesity risk.
• Sub-Saharan Africa is forecast to bear around 70% of the amenable health burden linked to a collapse in development assistance for health.

Dr. Richard Horton, Editor-in-Chief of The Lancet adds: "This Lancet Commission offers a radical conceptual shift in the way we think about future threats to human survival. It invites us to expand the array of dangers facing humanity, moving from single issues to a broader and more complex landscape of threats, which demands a much more extensive framework for coordinated action. The jeopardies that face us are multiple. Our solutions need to match that reality."

Build, back, track: a global call to action

Proven and emerging solutions for most of the threats to health already exist and are ready to be scaled up and implemented – from medicines and health technologies to proven public policies - while others require targeted investment and innovation to reach their full potential.

For the first time, the Commission gives decision-makers a common framework to inform action before harm becomes embedded, with a clear three-part agenda:

1. Build readiness – create and fund threat-ready health systems with dedicated teams for foresight, prevention, preparedness and protection across a wide range of risks. These capabilities should be embedded in how health systems are funded and delivered, supported by durable financing rather than ad hoc crisis responses, and designed to reach lower-resource settings and marginalized communities, not just wealthier populations.
2. Back breakthroughs – increase investment in innovation where existing tools are insufficient, including new vaccines, antibiotics, obesity treatments and climate technologies, alongside appropriate governance and equitable access.
3. Track threats – reassess threats regularly and independently so that evidence keeps pace with emerging and changing risks and reaches decision-makers in finance and security as well as health, including the creation of the Lancet Monitor of 21st Century Global Threats to Health to provide an institutionalized mechanism for tracking emerging risks.

Without action, each of the 17 catastrophic threats presents significant risks requiring timely attention. Many of the threats are also interconnected and should not be viewed in isolation. The Commission's framework is meant to help decision-makers identify opportunities for collaborative, cross-sectoral action that can build stronger societies that are resilient to global threats.

Commission Co-Chair Dr. Kanem notes: "Recent global events show us just how quickly stability can give way to crisis, and how costly it is to respond only after disaster strikes. And the global threats to health risk amplifying existing inequalities, with the greatest burden falling on the most vulnerable communities. Yet the future is not inevitable. The Commission makes a compelling case for reshaping the future by embedding foresight into decision-making. Governments and communities must act decisively starting today, to protect health and build a fairer, more peaceful and more secure future for the coming generations."

An accompanying Lancet Editorial says: "It is important to be clear about what this Commission is and what it is not. The Commission does not present a fixed ranking of threats or policy priorities. On the contrary, the report emphasises that its analysis should be seen as a dynamic process - its findings will probably change as new evidence and data are accrued…We believe this Commission can catalyse international, regional, and national actions to protect and strengthen the future of health and humanity. Doing so will require all of us to think much more broadly about where the biggest threats lie."

Post-embargo link to the report and all related content (live once the embargo lifts at 00.01 on Sunday 11 October): www.thelancet.com/commissions-do/global-threats-to-health